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Guidelines for proving your claim
with medical evidence
Medical evidence and the OWCP principle
of “Performance of Duty”
If you are seeking benefits under OWCP
you have the burden of proving the
essential elements of your claim. One of
those essential elements that you must
prove to OWCP is that your injury or
illness was sustained in the performance
of your duties with the USPS. In order
to establish that your claim meets the
performance of duty principle you must
provide the following documentation:
• Medical evidence that clearly
establishes the existence of the medical
condition for which you are cleaning
compensation.
• A factual statement that identifies
the work factors or incidents that you
believe have caused or contributed to
your medical condition.
• Medical evidence that states clearly
and to a medical certainty that the job
factors or incidents that you have
identified are indeed the proximate
cause of your claimed medical condition.
• Stated in another way, you must
provide OWCP medical evidence that
establishes clearly and to a medical
certainly that the diagnosed medical
condition is causally related to (caused
by) the job factors or incidents that
you have identified.
• All medical evidence must be through
and rationalized. Rationalized medical
evidence means that your physician must
provide in writing logical explanations
regarding his/her opinions, reasons, and
beliefs concerning the casual
relationship between the diagnosed
medical condition and the job factors or
incidents that you have identified as
having caused your injury or illness.
• Medical statements must be written in
a manner that demonstrates that your
physician’s opinion is based on your
complete factual and medical background
and is supported by a full understanding
of the workplace factors that directly
caused your claimed medical condition.
An employee who files a claim has the
burden of prove and MUST furnish
essential medical evidence to
substantiate an employment-related
medical condition and/or disability. The
best kind of evidence is a medical
report that includes:
• Dates of examination and treatment.
• Relevant medical histoty.
• Description of the work that was being
performed when this injury occurred.
• Detailed description of physical
findings, results of all diagnostic
tests, and course of treatment.
• Diagnosis with full medical
terminology.
• Physician’s opinion and supporting
medical rationale as to the relationship
of the disability or disease to the work
injury or factors of employment believed
to be the cause. The physician should
explain the physiological mechanism by
which the condition has resulted and
give the specific circumstances and
objective objective evidence which
support casual relationship.
• Medical opinion with documentation
regarding the precise extent and
duration of total or partial disability,
and prognosis for recovery.
NOTE: A narrative report with employee’s
history and the physician’s opinion with
medical rationale are essential. A mere
check of “yes” on a form in answer to a
question about casual relationship does
not normally constitute sufficient
medical evidence for a claim to be
accepted by OWCP. Also, if hospitalized,
the employee should contact the medical
record department of the hospital and
arrange for the hospital record to be
sent to the OWCP. These records should
include: consultant reports: x-rays and
laboratory studies; surgical report; and
discharge summary.
INFORMATION WHICH YOUR PHYSICIAN SHOULD
INCLUDE IN A FULL NARRATIVE MEDICAL
REPORT ESPECIALLY IF IT IS IN SUPPORT OF
A MORE COMPLEX OWCP CLAIM
• Patient’s name and address and OWCP
file number.
• Reference to the injury and to the
employment conditions involved (brief
description of both the patient’s
medical and employment history)
• Definitive diagnosis (no impressions),
prognosis and future medical care.
• Date of latest examination and/or
treatment.
• Nature and type of treatment since
last medical report.
• Statement describing any apparent
concurrent medical conditions even if
Unrelated to the work injury or
occupational disease.
• Nature of disability and the extent of
disability, that is, specify whether the
disability was total or partial. If
partial describe the specific work
limitations (medical restrictions).
The work limitations should describe the
limitation on walking, standing,
sitting, lifting, etc, and include the
number of hours allowed for each day
(refer to Form CA-17, “Duty Status
Report”). The limitations should also
include any disability from an apparent
concurrent medical condition unrelated
to the work injury or occupational
disease.
• Expected duration of the period of
disability.
• If the medical condition causing
disability was an underlying or
pre-existing (non-work-related)
condition aggravated by the work
incident, is the aggravation continuing
and is it a permanent or temporary
aggravation? Provide clear medical
rationale.
• Statement concerning whether maximum
medical improvement (MMI) has been
reached. If the patient is at MMI, are
there permanent medical restrictions?
* Signature of physician (show specialty
/ Board certification, and date).
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